Preinjury statin use is associated with improved in-hospital survival in elderly trauma patients

David T. Efron, Gary Sorock, Elliott R. Haut, David Chang, Eric Schneider, Ellen MacKenzie, Edward E. Cornwell, Gregory Jurkovich

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND: Recent evidence demonstrates improved survival for septic and bacteremic patients receiving 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins). Victims of severe traumatic injury share similar inflammatory cascades to those seen in septic patients. We hypothesized that elderly (aged ≥65 years) trauma patients might derive a similar outcome benefit from preinjury statin use. METHODS: Using the National Study on the Costs and Outcomes of Trauma database (collected from 69 hospitals) we conducted a retrospective observational cohort study of the effects of preinjury statin use on in-hospital mortality. Elderly patients were identified as having suffered moderate-to-severe traumatic injury (Abbreviated Injury Scale score ≥3). All hospital deaths and a sample of patients discharged alive were included for study. Multivariable analysis was performed including statin use, sex, age, comorbidities (myocardial infarction, stroke, arrhythmia, peripheral vascular disease, congestive heart failure, hypertension, diabetes, chronic obstructive pulmonary disease, renal disease), smoking, β-blocker use, New Injury Severity Score, Glasgow Coma Scale, cerebral midline shift, trauma center treatment, shock, and infection. RESULTS: A total of 1,224 elderly patients met the inclusion criteria for analysis of these patients, 21.1% were on statin therapy at the time of injury. Preinjury statin treatment was associated with a 67% reduction in the multivariable adjusted odds of in-hospital mortality (compared with statin nonusers; odds ratio, 0.33, 95% confidence interval [CI]: 0.12-0.92, p = 0.04). When stratified by the absence and presence of cardiovascular comorbidities, multivariable adjusted odds for statin use were 0.30 (95% CI: 0.10-0.91, p = 0.03) and 1.4 (95% CI: 0.72-2.72, p = 0.31), respectively. CONCLUSION: Preinjury statin use in elderly patients is associated with a significant survival benefit after major trauma, but only in patients without preexisting cardiovascular disease.

Original languageEnglish (US)
Pages (from-to)66-73
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume64
Issue number1
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Survival
Wounds and Injuries
Confidence Intervals
Hospital Mortality
Comorbidity
Abbreviated Injury Scale
Cohort Effect
Glasgow Coma Scale
Preexisting Condition Coverage
Injury Severity Score
Peripheral Vascular Diseases
Trauma Centers
Chronic Obstructive Pulmonary Disease
Observational Studies
Cardiac Arrhythmias
Shock
Oxidoreductases
Cohort Studies
Cardiovascular Diseases

Keywords

  • Elderly
  • Mortality
  • Statins
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Preinjury statin use is associated with improved in-hospital survival in elderly trauma patients. / Efron, David T.; Sorock, Gary; Haut, Elliott R.; Chang, David; Schneider, Eric; MacKenzie, Ellen; Cornwell, Edward E.; Jurkovich, Gregory.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 64, No. 1, 01.01.2008, p. 66-73.

Research output: Contribution to journalArticle

Efron, David T. ; Sorock, Gary ; Haut, Elliott R. ; Chang, David ; Schneider, Eric ; MacKenzie, Ellen ; Cornwell, Edward E. ; Jurkovich, Gregory. / Preinjury statin use is associated with improved in-hospital survival in elderly trauma patients. In: Journal of Trauma - Injury, Infection and Critical Care. 2008 ; Vol. 64, No. 1. pp. 66-73.
@article{927400a01dc1472880f271d8bfba926a,
title = "Preinjury statin use is associated with improved in-hospital survival in elderly trauma patients",
abstract = "BACKGROUND: Recent evidence demonstrates improved survival for septic and bacteremic patients receiving 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins). Victims of severe traumatic injury share similar inflammatory cascades to those seen in septic patients. We hypothesized that elderly (aged ≥65 years) trauma patients might derive a similar outcome benefit from preinjury statin use. METHODS: Using the National Study on the Costs and Outcomes of Trauma database (collected from 69 hospitals) we conducted a retrospective observational cohort study of the effects of preinjury statin use on in-hospital mortality. Elderly patients were identified as having suffered moderate-to-severe traumatic injury (Abbreviated Injury Scale score ≥3). All hospital deaths and a sample of patients discharged alive were included for study. Multivariable analysis was performed including statin use, sex, age, comorbidities (myocardial infarction, stroke, arrhythmia, peripheral vascular disease, congestive heart failure, hypertension, diabetes, chronic obstructive pulmonary disease, renal disease), smoking, β-blocker use, New Injury Severity Score, Glasgow Coma Scale, cerebral midline shift, trauma center treatment, shock, and infection. RESULTS: A total of 1,224 elderly patients met the inclusion criteria for analysis of these patients, 21.1{\%} were on statin therapy at the time of injury. Preinjury statin treatment was associated with a 67{\%} reduction in the multivariable adjusted odds of in-hospital mortality (compared with statin nonusers; odds ratio, 0.33, 95{\%} confidence interval [CI]: 0.12-0.92, p = 0.04). When stratified by the absence and presence of cardiovascular comorbidities, multivariable adjusted odds for statin use were 0.30 (95{\%} CI: 0.10-0.91, p = 0.03) and 1.4 (95{\%} CI: 0.72-2.72, p = 0.31), respectively. CONCLUSION: Preinjury statin use in elderly patients is associated with a significant survival benefit after major trauma, but only in patients without preexisting cardiovascular disease.",
keywords = "Elderly, Mortality, Statins, Trauma",
author = "Efron, {David T.} and Gary Sorock and Haut, {Elliott R.} and David Chang and Eric Schneider and Ellen MacKenzie and Cornwell, {Edward E.} and Gregory Jurkovich",
year = "2008",
month = "1",
day = "1",
doi = "10.1097/TA.0b013e31815b842a",
language = "English (US)",
volume = "64",
pages = "66--73",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Preinjury statin use is associated with improved in-hospital survival in elderly trauma patients

AU - Efron, David T.

AU - Sorock, Gary

AU - Haut, Elliott R.

AU - Chang, David

AU - Schneider, Eric

AU - MacKenzie, Ellen

AU - Cornwell, Edward E.

AU - Jurkovich, Gregory

PY - 2008/1/1

Y1 - 2008/1/1

N2 - BACKGROUND: Recent evidence demonstrates improved survival for septic and bacteremic patients receiving 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins). Victims of severe traumatic injury share similar inflammatory cascades to those seen in septic patients. We hypothesized that elderly (aged ≥65 years) trauma patients might derive a similar outcome benefit from preinjury statin use. METHODS: Using the National Study on the Costs and Outcomes of Trauma database (collected from 69 hospitals) we conducted a retrospective observational cohort study of the effects of preinjury statin use on in-hospital mortality. Elderly patients were identified as having suffered moderate-to-severe traumatic injury (Abbreviated Injury Scale score ≥3). All hospital deaths and a sample of patients discharged alive were included for study. Multivariable analysis was performed including statin use, sex, age, comorbidities (myocardial infarction, stroke, arrhythmia, peripheral vascular disease, congestive heart failure, hypertension, diabetes, chronic obstructive pulmonary disease, renal disease), smoking, β-blocker use, New Injury Severity Score, Glasgow Coma Scale, cerebral midline shift, trauma center treatment, shock, and infection. RESULTS: A total of 1,224 elderly patients met the inclusion criteria for analysis of these patients, 21.1% were on statin therapy at the time of injury. Preinjury statin treatment was associated with a 67% reduction in the multivariable adjusted odds of in-hospital mortality (compared with statin nonusers; odds ratio, 0.33, 95% confidence interval [CI]: 0.12-0.92, p = 0.04). When stratified by the absence and presence of cardiovascular comorbidities, multivariable adjusted odds for statin use were 0.30 (95% CI: 0.10-0.91, p = 0.03) and 1.4 (95% CI: 0.72-2.72, p = 0.31), respectively. CONCLUSION: Preinjury statin use in elderly patients is associated with a significant survival benefit after major trauma, but only in patients without preexisting cardiovascular disease.

AB - BACKGROUND: Recent evidence demonstrates improved survival for septic and bacteremic patients receiving 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins). Victims of severe traumatic injury share similar inflammatory cascades to those seen in septic patients. We hypothesized that elderly (aged ≥65 years) trauma patients might derive a similar outcome benefit from preinjury statin use. METHODS: Using the National Study on the Costs and Outcomes of Trauma database (collected from 69 hospitals) we conducted a retrospective observational cohort study of the effects of preinjury statin use on in-hospital mortality. Elderly patients were identified as having suffered moderate-to-severe traumatic injury (Abbreviated Injury Scale score ≥3). All hospital deaths and a sample of patients discharged alive were included for study. Multivariable analysis was performed including statin use, sex, age, comorbidities (myocardial infarction, stroke, arrhythmia, peripheral vascular disease, congestive heart failure, hypertension, diabetes, chronic obstructive pulmonary disease, renal disease), smoking, β-blocker use, New Injury Severity Score, Glasgow Coma Scale, cerebral midline shift, trauma center treatment, shock, and infection. RESULTS: A total of 1,224 elderly patients met the inclusion criteria for analysis of these patients, 21.1% were on statin therapy at the time of injury. Preinjury statin treatment was associated with a 67% reduction in the multivariable adjusted odds of in-hospital mortality (compared with statin nonusers; odds ratio, 0.33, 95% confidence interval [CI]: 0.12-0.92, p = 0.04). When stratified by the absence and presence of cardiovascular comorbidities, multivariable adjusted odds for statin use were 0.30 (95% CI: 0.10-0.91, p = 0.03) and 1.4 (95% CI: 0.72-2.72, p = 0.31), respectively. CONCLUSION: Preinjury statin use in elderly patients is associated with a significant survival benefit after major trauma, but only in patients without preexisting cardiovascular disease.

KW - Elderly

KW - Mortality

KW - Statins

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=38149013062&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=38149013062&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e31815b842a

DO - 10.1097/TA.0b013e31815b842a

M3 - Article

C2 - 18188101

AN - SCOPUS:38149013062

VL - 64

SP - 66

EP - 73

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -